Healthcare Provider Details

I. General information

NPI: 1265016430
Provider Name (Legal Business Name): BENJAMIN L MCINTOSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 N 40TH ST STE 103
PHOENIX AZ
85018-2158
US

IV. Provider business mailing address

3104 E CAMELBACK RD # 1003
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 602-952-8111
  • Fax: 602-952-1572
Mailing address:
  • Phone: 602-952-8111
  • Fax: 602-952-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number79974
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: